The study was undertaken to investigate whether the two major monocyte subsets defined by the surface markers CD14(+)CD16(+) and CD14(++)CD16(-) show differences in their responses to hypercholesterolemia. Monocytes were rapidly isolated from the blood of hypercholesterolemic, low-density lipoprotein (LDL) receptor-defective familial hypercholesterolemia (FH) patients and from control persons. Using flow cytometry and uptake, adhesion, and phagocytosis assays as well as laser scanning microscopy, we found significant differences between the monocyte subsets. FH-CD14(+)CD16(+) monocytes exhibit an increased uptake of oxidized LDL (oxLDL) via CD36, whereas FH-CD14(++)CD16(-) monocytes preferentially take up native LDL (nLDL). FH-CD14(+)CD16(+) monocytes have an increased expression of surface proteins CD68, stabilin-1, and CD11c and a higher adherence to activated endothelial cells in response to oxLDL and nLDL stimulation. In addition, all CD14(+)CD16(+) monocytes have an increased ability for phagocytosis and a higher resistance to phagocytosis impairment by oxLDL compared with CD14(++)CD16(-) monocytes. We conclude that FH-CD14(+)CD16(+) monocytes have specialized functions in the uptake of oxLDL at activated endothelial cell surfaces, and we hypothesize that these functions are critical for the clearance of oxLDL deposits and apoptotic cells from the vessel wall under hyperlipidemic conditions.